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Wednesday, April 19, 2006

In this week’s issue of the Lancet (The Lancet 2006; 367:1227-1228; subscription required but access is free), Hannah Roberts reports on the increasing practice of hymen reconstruction on women in Guatemala to “restore virginity.” I learned of this article and issue reading Stuart Rennie's globalbioethicsblog. This “intimate surgery” as it is called is accounted for because: “Women are expected to be virgins when they marry; in some communities blood evidence from the wedding night is still required for verification by the family. The profound societal significance of bridal virginity is such that women are prepared to compromise their physical health to remain socially acceptable.” Those who perform this expensive surgery (app. $1000US) are not usually licensed health care workers, are found through hand-painted advertisements on walls, provide unsafe operating conditions, and rarely provide follow-up appointments. Women who have undergone this procedure are showing up in hospitals presenting with infections, hemorrhaging, incontinence, fistulas, and extreme pain during sexual intercourse.

Roberts reports that Guatemala has one of the worst records in Central America for reproductive health with high rates of maternal and infant mortality and low levels of knowledge about contraception. (She cites: In some parts of the country, 42·1% of the population had not heard of HIV/AIDS; 2·3% of the women chose condoms as their preferred method of contraception; just over 40% of women had used any form of contraception at all.) This situation is referred to as a crisis.

While activists campaign for stronger legal regulation of reproductive-health information and services, and have support for such in the Guatemala Parliament, the President of the country and the Roman Catholic church are thwarting efforts towards the goal of women’s reproductive health.

Guatemala has a population of approximately 13 million people and is the most populous country in Central America. The population is approximately half indigenous, Mayan. Spanish is the official language but Mayan languages are spoken alongside Spanish. The distribution of income is highly unequal with perhaps 75% of the population below the poverty line. From 1960, the people of Guatemala endured 36 years of bloody civil war between a series of military regimes and anti-government guerrillas which left up to 200,000 people dead and many “disappeared.” According to MADRE, “Behind the smokescreen of "fighting communism," military groups trained and funded by the US killed mostly Indigenous people and destroyed 440 Mayan villages. More than a million people were uprooted from their homes and over a quarter million became refugees in surrounding countries.” In 1992, Rigoberta Menchu, a Mayan rights activist was awarded the Nobel Peace Prize. In 1996, Guatemalans celebrated the signing of Peace Accords, however, the country is still marked by violence and corruption and according to Amnesty International, has witnessed over 1500 brutal killings of women since 2001. There has been a marked lack of thorough and impartial investigation into these and other violent crimes against women. The recent AA report (April 1 2006) concludes that: ”the State of Guatemala is not taking effective action to eliminate gender discrimination in the criminal justice system, ensure proper investigations and bring those responsible for the killing of women to justice. This failure has meant increased suffering on the part of relatives of women killed, which Amnesty International believes amounts to cruel, inhuman and degrading treatment.”

During the civil war, the Roman Church and other religious organizations took a leadership role in giving material, psychological and spiritual aid to victims; sometimes it engaged in political activities and church members were disappeared and murdered. But Church teachings about the morality of reproduction are affecting public health policy in the country to the detriment of women’s reproductive health. Women of the country overwhelming want access to family planning information and services, but it is not being provided. Moreover, international funding for reproductive health programs has been cut off as a consequence of the current US administration's hostility to modern family-planning methods. See: http://www.reproductiverights.org/pdf/guatemala.pdf

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